Phlebotomy TodaySTAT!

December, 2017

Bugs on Scrubs

It's flu season on the south wing. At the same time, an epidemic of C. diff patients has hit the ER. You've been drawing blood from both units all week, but you don't mind. You're in healthcare because you enjoy helping the sick and injured get healthy and stay healthy.

Today, the pant legs of your scrubs are dragging on the floor as they have all week. They never really fit you, but you've never found the time to hem them up. Given the germs you've been working around lately, you think this might be a good day to replace them.

On your way home, you stop at the grocery store, still in your scrubs and work shoes. The elderly man directly behind you in the checkout line drops his package of ground beef on the floor where you were standing moments ago. He's going to take it home and make dinner for his wife. You'll recognize him next week when he brings his wife into the ER for dehydration secondary to diarrhea.

Then you go home, happy to be in the comfort of your own home. You walk in the side door, put away your groceries, and walk into your baby's carpeted bedroom for hugs. Your toddler gets the hugs, the carpet gets the bugs. He'll crawl around there later tonight and collect them on his hands. Next week you'll miss work so you can take him to the pediatrician for his flu-like symptoms.

Healthcare has a dirty little secret. We all know we must work diligently to prevent infections from spreading from patient to patient, but too often we stop thinking about infection control when our shift is over. That's when a healthcare-acquired infection (HAI) becomes a community-acquired infection, as illustrated above. Are you taking work home with you?

Clostridium difficile is responsible for 250,000 infections per year requiring hospitalization (or affecting already-hospitalized patients) and 14,000 deaths. Ninety percent of deaths occur in people 65 and older. C. difficile spores can survive for months on environmental surfaces. The CDC has categorized the organism as an urgent threat.

C. diff is not the only pathogen healthcare workers can carry into the community. A recent study found that lab trays, carts and other hospital equipment contaminated with the hepatitis C virus (HCV) can remain infective for 6 weeks at room temperature, increasing the risk of accidental contact and spread of the virus.

According to another study, staphylococci and enterococci are able to survive on fabrics up to 56 days. Yet in most facilities healthcare staff is allowed to leave work wearing their infected scrubs and lab coats to shop, make dinner, and play with their children.

Our communities would be less threatened if healthcare workers employed standard precautions and personal protective equipment strictly and without exception. Unfortunately, that's not the case. One study showed that only 62% of healthcare staff regularly used proper PPE. Another study showed 65 percent of nurses who performed patient-care activities on patients with MRSA-infected wounds or urine contaminated their uniforms or gowns with the pathogen. The same study showed environmental contamination occurred in the rooms of 73% of infected patients. In a third study, it was found that hand-hygiene compliance was only 50 percent, and as low as 30 percent at the time healthcare workers interact with patients.

Therefore, at any given time everything in any patients' room can be contaminated with the pathogen for which they're being treated. Enter the room without PPE and the pathogen contaminates your scrubs and lab coats and leaves with you, eventually spreading into the community where you shop and visit. Eventually it comes home with you.

Many studies have shown that soft surfaces (lab coats, scrubs, uniforms, privacy curtains, patient apparel and bed linens) in the healthcare environment are contaminated. One showed that up to 58% of chairs and couches used by VRE patients were contaminated. Another study found 42% of hospital privacy curtains were contaminated with vancomycin-resistant enterococci, 22% with methicillin-resistant Staphylococcus aureus, and 4% with C. difficile.

So when healthcare professionals touch environmental surfaces, it contaminates their hands. That's not a problem when hands are washed after patient contact. However, if you have a habit of pushing up your sleeves with contaminated hands before hand-washing, then pulling them back down, you've just recontaminated your hands.

According to CLSI's Clinical Laboratory Safety; Approved Guidelines, pants worn by lab staff should be 1-1 1/2 inches off the ground to maintain cleanliness. What is your facility's policy regarding the length of scrub pants? Walk around today and see if the staff is compliant. If not, it's time to make everyone aware of the risk and the regulations. Then enforce the policy.

Your facility probably launders lab coats you wear, but who launders your scrubs? If you're washing them at home with the rest of your family's laundry, are you aware that the wash and dry cycles need to be 25 minutes and the wash water temperature must be above 160°F or you must add bleach to properly disinfect contaminated clothing? Are you aware that fabric softeners compromise the material's barrier protection?

In 2007 the UK's National Health Service (NHS) banned jewelry, long sleeves, ties and other clothing that cannot be changed or disinfected before patient contact. It reduced HAIs from MRSA 80 percent. Facilities outside of the UK may consider adopting the same policy for their staff. Scrubs worn out of the hospital can carry germs out with them and unknowingly endanger others. Do your part; make sure your scrub pants are properly hemmed and start changing out of your scrubs and shoes at work.

The next time you're in the grocery store, take note of those shopping in their scrubs. Pay particular attention to the length of their pant legs. If they're dragging on the ground, don't drop your hamburger.

Product Spotlight: Phlebotomy Central membership

We've been building it for years; now it's enormous. We're talking about the most comprehensive collection of blood specimen collection information on the Internet, fully updated to reflect the newly revised CLSI venipuncture standard.

Join Phlebotomy Central and your facility will have 24/7 access to the most comprehensive body of knowledge on blood specimen collection ever assembled online with over 500 articles and resources to help you teach, train, and manage specimen collection personnel.

Sections include:

Phlebotomy Today archives--- over 200 back issues going all the way back to 2001;

The Manager's Toolbox – a growing list of documents, competency checklists, SmartCharts™, and procedure templates that managers and educators can use to enhance their understanding of preanalytical processes and manage their staff more effectively;

FAQs – Exclusive to Phlebotomy Central members, answers to hundreds of the most frequently asked questions, searchable by keyword or phrase;

To The Point Volumes 1-6--- a compilation of our To The Point downloads into booklets worth up to 6.5 PACE credits each with or without PACE credit. (Certificate processing fee required to receive PACE credit).

It's often been said the next best thing to knowing a fact is knowing where to find it. You'll find it in Phlebotomy Central.

What Should We Do?: Gauze wraps on infant heels

Dear Center for Phlebotomy Education:

Our staff is concerned about having to hold onto a squirming, crying baby's heel long enough for it to stop bleeding. Parents also are anxious to get going home. So can my staff use a non-adhesive bandage like CobanTM to help slow the bleeding and let the parents hold the child until they calm down? This would allow the baby time to settle down and the bleeding would stop more quickly.

Our response:

Such a remedy would be acceptable if the phlebotomist removed it after bleeding has stopped. Even though it's less of a choking risk than an adhesive bandage, if the baby was sent home with a Coban-type wrap and actually choked on it, a savvy lawyer might try to convince a jury it's still technically a "bandage" and therefore a violation of the standard for infant heelsticks. It's unfortunate we have to think in those terms, but this is all about risk management.

Personally, we feel it's exceedingly unlikely, and it may be a viable alternative to bandaging. This does not constitute legal or medical advice, however, just our two cents. You should consider this option with your risk manager.

Got a challenging phlebotomy situation or work-related question? Email us your submission at WSWDpanel@phlebotomy.com and you just might see it as a future case study. (Names and identifiers will be removed to assure anonymity.)

Order of Draw Badge Tags

Do those who draw blood samples in your facility realize the order of draw is critical to accurate results, or do they think it's a myth? If they think it's a myth, the Center for Phlebotomy Education can help dispel it.

First, print our PDF titled Do I have to Follow the Order of Draw from our Free Stuff web page and post it where everyone who draws blood can see it.

Secondly, distribute our Order of Draw Badge Tag to your staff to attach to their ID badge so the order of draw is always in front of them. The Order of Draw Badge Tag graphically depicts the order of draw and explains why it's necessary. On the reverse are nine tips on proper tube filling and handling including:

Fill all tubes according to the proper order of draw

Mix all tubes with a gentle inversion 5-8 times, 3-5 times for citrate tubes

When filling tubes from a syringe, always use a safety-transfer device.

The Order of Draw Badge Tag is printed in full color and laminated for durability. Each 10-pack contains 10 identical copies of the card for distribution to phlebotomists, nurses and all on staff who draw blood samples.

Phlebotomist Now Closing Million-Dollar Deals

It's often been said phlebotomy is a gateway profession. For phlebotomist Amanda Craven, the gateway opened an opportunity for her to sell close to $1 million in contracts for her employer, Associated Pathology Medical Group in San Francisco.

According to an article in Forbes, Craven credits her respect for potential customers, her medical industry expertise and her inexhaustible patience to attract potential customers naturally. Although she's still a California-licensed phlebotomist, Craven now spends her time visiting medical practices across Northern California recruiting Associated Pathology's anatomical pathology laboratory services.

It's a far cry from her days drawing blood at the UC Davis Medical Center, but the phlebotomist-turned-salesperson seems to have found her niche. Even though she used to consider sales positions equivalent to "greasy car salesmen," she apparently has found a way to keep the gatekeepers in the laboratory industry from casting her in the same light.

Standards Update: Patient identification

The newly revised venipuncture standard released by the Clinical and Laboratory Standards Institute in April, 2017 is the most comprehensive revision in the document's history. With over 140 new mandates, facilities have a lot of changes to implement. This series discusses one or more substantive changes each month.

As of last April, managers who have not updated their procedure for identifying patients are likely operating beneath the standard of care. Because patient identification continues to plague healthcare, especially when blood samples are drawn, the new standard beefs up the requirements and significantly changes the patient identification protocol every facility must employ to be current with the industry standard.

It the past, patients had to verbalize their full name, birth date, address, and/or unique identifier. The new standard requires patients to state their full name and birth date, and spell their first and last names.1 For patients who are unable to speak or for whom there is a language barrier or cognitive impairment, a caregiver or family member must provide the information. The information provided must then be compared with the ID band and the orders, requisition, or labels for the sample. The ID band must be attached to the patient. If attached to the bed, placed on a nightstand, or anywhere else than on the patient, it cannot be considered as a valid ID band.

For outpatients without ID bands, an identification card or some other form of ID must be provided, and the same comparisons made with the orders. Studies have found up to 16 percent of ID bands are missing or contain erroneous information.2,3

Asking the patient to state his/her full name and birth date rather than affirming information the collector verbalizes is critical. If the collector were to state the name and birth date and seek the patient's affirmation, the patient may affirm a name that was not properly understood just to be polite and accommodating.

Editor's note: Readers are urged to obtain their own copy of the standard as soon as possible and begin implementing all new provisions as soon as possible. The document, Collection of Diagnostic Venous Blood Specimens (GP41-A7), is the standard to which all facilities will be held if a patient is injured during the procedure or suffers from the consequences of an improperly performed venipuncture.

Empowered Healthcare Manager

The worst phrase a manager can ever use

"To be honest with you..."

Do you know someone who starts statements with this self-exposing preface? If you didn't know them any better, aren't they inviting you not to believe anything that comes out of their mouth unless it's first introduced as honesty? Isn't it an admission that everything else they say is fiction, fabrication, and falsehood?

It may not be, but you're entitled to wonder.

Perhaps it's just a habit, a manner of speaking. Yet, flagging a forthcoming statement in this way sends the following message:

I usually mislead people, sugar-coat the truth, or spin things, but what I'm about to say is how I really feel. So I need to warn you the comment I'm about to make is honest, sincere, and unfiltered for a change. Nothing else I say should be taken as genuine.

Worse yet is this variation: "To be perfectly honest with you..." Translation: "Whenever I say I'm being honest, I'm not always that honest. But this time I'm being perfectly honest. Really."

Managers who use either phrase are sending a self-defaming message, and risking their staff's confidence, trust, and loyalty. Who wants to follow someone who readily admits they're not always honest? Who wants to manage someone like that?

Trivial as it may seem, words have meaning and consequence. Don't underestimate the power of this phrase to call credibility into question. The workplace---and the world at large---would be far better if, instead of introducing the truth before it came out, people would introduce the falsehoods.

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